· Drink home-made sugar-salt solution, lemon water, lassi, torani (rice-water) and buttermilk etc as and when possible. Warning: if you are on a low-salt diet, talk with your doctor before drinking a sports beverage.

· Help your body stay cooler when you go back into the heat.

· Electric fans may provide comfort, but when the temperature is between 35°C and 38°C (95°F and 99°F) fans will not prevent heat-related illness. If possible, take a cool shower or bath when back to home after attending school

· Wear lightweight, light-coloured, loose-fitting clothing. Use sun-glass and cover your head with cloth or a cap or umbrella. Do not go out barefoot instead wear light shoes.

· Never leave anyone in a closed, parked vehicle. School buses should be parked under shadows and the windows and doors should be opened for 15 minutes before children board the bus.

· If you must be out in the heat:

o Cut down on exercise. If you must exercise, drink water as much as you need it

o Try to rest often in shady areas.

o Protect yourself from the sun by wearing a wide-brimmed hat (also keeps you cooler) and sunglasses and by putting on sunscreen protection factor of 15 or higher (the most effective products carry “broad spectrum” or “UVA/UVB protection” on their labels).

· Keep windows of class room open if it is not air-conditioned

Despite all preventive measures, if a child still falls victim of heatwave then follow the measures against the symptoms of various grades of heatwaves detailed in table below:

Table: Heat-related medical conditions, symptoms and management

Medical conditions

Signs and symptoms/mechanisms

Management

Heat rash

Small, red, itchy papules appear on the face, neck, upper chest, under breast, groin and scrotum areas. This is prevalent in young children.

Rash subsides with no specific treatment. Minimize sweating by staying in a cool environment, taking frequent showers using soap and wearing light clothes. Keep the affected area dry. Topical antihistamine and antiseptic preparations can be used to reduce discomfort and prevent secondary infection.

Heat Oedema

Swelling of the lower limbs, usually ankles, appears at the start of the hot season. This is attributed to heat-induced peripheral vasodilation and retention of water and salt.

Treatment is not required as oedema usually subsides following acclimatization.

Heat syncope

This involves brief loss of consciousness or dizziness. It is common in patients with heart diseases.

The affected child should rest in a cool place and be placed in a supine position with legs and hips elevated to increase venous return. Consult medical doctor for appropriate advice.

Heat cramps

Painful muscular spasms occur, most often in the legs, arms or abdomen, usually at the end of sustained exercise.

Immediate rest in a cool place is advised. Stretch muscle and massage gently. Oral rehydration solution or sugar-lemon mix solution may be needed. Medical attention should be sought if heat cramps are sustained for more than one hour.

Heat exhaustion

Symptoms include intense thirst, weakness, discomfort and headache, anxiety, dizziness, fainting and headache. Core temperature may be normal, subnormal or slightly elevated (less than 400C). Pulse is thready and rapid shallow breathing. There is no alteration of mental status. This can be attributed to water and/or salt depletion resulting from exposure to high environmental heat or strenuous physical exercise.

Move the affected child to a cool, shaded room or air conditioned place. The affected child should be undressed. Apply cold wet sheet or spray cold water and use fan if available. Lay the child down and raise his or her legs and hips to increase venous return. Start oral rehydration. If nausea prevents oral intake of fluids, consider transferring the affected person to a hospital.